Subject: Clarification on Water Damage Coverage under HO3 Policy with Citizens
Hello everyone,
I have an HO3 policy with Citizens in Florida, and I’m trying to get a clearer understanding of when they cover water damage. Unfortunately, I’ve been unable to get satisfactory answers from their representatives, my insurance agent, or the adjuster. I currently have water damage beneath my flooring, but despite the efforts of the field adjuster, a water mitigation company, and a leak detection specialist, the exact source of the leak remains unidentified. Now, Citizens wants to send out an inspector, which makes me suspect they could be looking to protect their interests.
To be proactive, I’m preparing for the possibility of a claim denial and considering bringing in independent experts to help assess the situation. I noticed a soft spot in my vinyl flooring, which is installed over hardwood, and after removing part of the vinyl, I found rotten wood underneath. There hasn’t been any visible water on the surface of the flooring.
From my research, I understand that Citizens excludes coverage for gradual leaks and seepage. However, there’s also a provision for hidden water damage caused by unknown leaks that are concealed under floors, in walls, or within ceilings. I’m curious about how this works in practice, especially given that there’s no active leak identified—it’s likely a result of something situational, hidden, or an accidental spill.
I’m struggling to interpret the fine print, as it offers conflicting information. I’ve included a link to relevant pages from my insurance declaration concerning water damage: Link to Insurance Declaration.
Could someone clarify if Citizens would cover scenarios like these?
- Moisture accumulation under flooring due to a failed vapor or moisture barrier?
- An AC leak within the walls stemming from a pipe failure or improper installation?
- Sporadic leaks from a poorly installed air handler?
- A broken condensate line or a sewage pipe leaking beneath the foundation?
- Historical water spills that may have seeped under the floor?
Has anyone experienced a situation with Citizens where they received claim approval for similar issues, or were these claims typically denied as maintenance problems? If they were approved, what kind of evidence was needed to support the claim?
I want to be well-prepared in case they push back on my claim. It’s been over a month, and I can’t commence renovations since the adjuster wants me to keep everything as is for the time being. Additionally, the adjuster has instructed me to keep the damaged flooring (which has mold) bagged inside my home and advised us to remain there—despite the water mitigation company stating there’s over 10 sq ft of mold and recommending we find alternative accommodations since we have a small child.
I would greatly appreciate any insights or advice you can share. Thank you!
I’m sorry to hear about your situation; dealing with water damage and insurance claims can be incredibly frustrating. Based on what you’ve described and your understanding of the HO3 policy with Citizens, here’s a breakdown of how they typically handle water damage claims:
Hidden Water Damage: Citizens does usually cover hidden water damage that is caused by sudden and accidental incidents, as long as the source was unknown and the damage was concealed. This would generally not include long-term or gradual leaks, which they often consider a maintenance issue.
Moisture Buildup and Gradual Leaks: Claims arising from gradual leaks or moisture buildup (like from a failed vapor barrier) are typically excluded. If the moisture accumulation is due to a problem that developed over time rather than a single, sudden incident, it may get denied.
AC Leaks and Pipe Failures: If an AC leak or pipe failure can be shown to have caused sudden damage (like a burst pipe), it may fall under coverage. Documentation of the leak (e.g., photos, reports from specialists) would be crucial.
Sporadic or Poor Installation Issues: Problems arising from poor installation or sporadic leaks may also fall into a gray area. If you can provide evidence that the damage was sudden and not due to neglect, you may have a stronger case.
Past Spills: Water spills that occurred in the past and are not associated with a current incident are usually not covered. The key here is demonstrating that the issue arose from something unexpected.
Next Steps:
Documentation: Keep thorough documentation of everything. This includes dates, communications with your insurance adjuster, reports from specialists, and photos of the damage and any work being done.
Independent Specialists: If you’re considering bringing in independent professionals, make sure they can provide detailed reports outlining the likely cause of the damage. This can help support your claim if it was a sudden incident and not a maintenance issue.
Communication with the Adjuster: Stay in contact with your adjuster and ask for clarification on parts of the policy that are vague. Document these conversations.
Claim Appeal: If your claim is denied, you have the right to appeal. In this case, having an independent assessment will be very beneficial.
Legal Consultation: If it continues to be challenging, consulting a lawyer who specializes in insurance claims might provide additional options and advocacy.
It’s unfortunate you’re dealing with mold issues as well. If you have children at home, prioritize your family’s safety, and consider temporary relocation if the mold situation worsens.
Wishing you the best in resolving this situation. It sounds complex, but with thorough evidence and communication with your insurer, you can navigate this challenge.